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FUNE LOCAL GOVERNMENT AREA APRIL/MAY ADAMU ABUBAKAR YERIMA
GARISSA COUNTY KENYA NOVEMBER 2013 MOH, ACF, MERCY USA, UNICEF, TDH, APD
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ACKNOWLEDGEMENT Appreciation goes to the following persons with whose efforts the SLEAC survey exercise was successful:
1. The entire survey team from Action Against Hunger | ACF - International, Mercy USA, UNICEF, TDH, APD who worked tirelessly in the entire survey process.
2. The MOH team in Garissa County for the key role in planning of sensitization meetings, field data collection and dissemination of results.
3. Communities living in Garissa County who allowed the teams to assess their children thus providing the survey team with the information required.
4. The MOH West Pokot team who were key in sensitization meeting and data collection supervision.
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ACRONYMS ACF Action Against Hunger | ACF - International APD Agency for peace and development CHMT County Health Management Team CHWs Community Health Workers DHIS District Health Information System DNO District Nutrition Officer FS&L Food Security and Livelihoods GAM Global Acute Malnutrition CMAM Community-based Management of Acute malnutrition CMN Coverage Monitoring Network CNC County Nutrition Coordinator IRC International Rescue Committee KRCS Kenya Red Cross Society LQAS Lot Quality Assurance Sampling MAM Moderate Acute Malnutrition MOH Ministry of Health MTMSGs Mother To Mother Support Groups MUAC Mid-Upper Arm Circumference NGO Non-governmental Organization OTP Outpatient Therapeutic Program PSU Primary Sampling Unit RUSF Ready to use Supplementary Food RUTF Ready to use Therapeutic Food SAM Severe Acute Malnutrition SFP Supplementary Feeding Program SDU Service Delivery unit SLEAC Simplified Lot Quality Assurance Sampling Evaluation of Access and Coverage SMART Standardized Monitoring and Assessment of Relief and Transitions SQUEAC Semi Quantitative Evaluation of Access and Coverage TDH Terre des homes UNICEF United nation children’s fund WASH Water, Sanitation and Hygiene WFP World Food Program
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EXECUTIVE SUMMARY The assessment was conducted to evaluate access and coverage of integrated management of acute malnutrition (IMAM) program among children aged 6 to 59 months with severe acute malnutrition (SAM) and moderate acute malnutrition (MAM). The most recent integrated nutrition survey1 carried out in April 2013 indicated wasting rates had reached the serious interpretation level2 with a Global Acute Malnutrition (GAM) rate of 12.0% (9.3-15.5 95%CI). No coverage assessment had been conducted before at Garissa County level. The program assessment was conducted in November 2013 using Simplified Lot Quality Assurance Sampling Evaluation of Access and Coverage (SLEAC) with the main objective of mapping out coverage at Sub-County level and also provides possible recommendations for program reforms. The assessment was a participatory process conducted with financial and human resources from Ministry of Health (MOH) Garissa County, Action Against Hunger (ACF), Mercy USA, UNICEF, Terre des homes (TDH), and Agency for peace and development (APD). Members from MOH West Pokot also participated as survey team supervisors; this was a follow up on enhancing capacity earlier built on SLEAC methodology3. Coverage was classified based on the coverage standards as follows:
Low coverage: 20% or less. Moderate: 20% up to less than 50%. High coverage: 50% and above.
The estimates in some Sub-Counties were below the SPHERE minimum standards of 50% for IMAM coverage in a rural setting. Results indicated that IMAM program coverage was patchy in the County with results summarised in table 1. Table 1: Summary of program coverage assessment results, Garissa County, November 2013 Sub-County OTP SFP 1. Fafi Moderate Moderate 2. Ijara High High 3. Garissa Low Moderate 4. Balambala High Low 5. Hulugho Moderate Moderate 6. Lagdera High High 7. Dadaab High Moderate Overall program coverage for Garissa County was 48.7% (40.9-56.5 95%C.I) and 40.7% (35.6-45.8 95% C.I) for Out Patient Therapeutic Program (OTP) and Supplementary Feeding Program (SFP) respectively. Table 2 summarizes some of the barriers to program coverage and access identified across the Sub-counties and possible recommendations. Further investigation using Semi Quantitative Evaluation of Access and Coverage (SQUEAC) is proposed in Sub-Counties with low (Garissa) and high (Lagdera) 1Garissa County SMART survey April 2013 2 WHO threshold 2006 3 Training on SLEAC methodology July 2013 in West Pokot
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OTP coverage. This will gather more evidence to inform program reforms.
Table 2: Summary of barriers and recommendations
Barriers Recommendations Lack of program awareness Advocate for integrated outreach activities; carer support
group trainings; continuous group health talks at health centre.
Long distance and competing household chores such as livestock herding leading to high defaulting.
Integrated outreach services should be undertaken in villages far from health facilities. Community mobilization and sensitization on importance of IMAM program should be enhanced. Active case finding and absentee/defaulter tracing should be emphasized. Need to support community units through engaging with Community Health Workers (CHWs) and reviving units which are not active.
Lack of /inconsistent supply of Ready to use Supplementary Food (RUSF) and Ready to use therapeutic Food (RUTF)
Ensure timely supply of the commodities by Kenya Red Cross (KRCS) /World Food Program (WFP) to the Sub-Counties. Improve on timely and accurate reporting of stock.
Low understanding on admission criteria to selective feeding program by the caregivers.
Enhancing community sensitisation on acute malnutrition and the treatment protocol. Ensure that rejected cases are told and made to understand reasons for non-admission. One of the ways to address this is for the program staff to explain to the caregivers the interpretation of the cut-off points and reasons why the program is selective.
Poor adherence to IMAM programs protocol by the health workers.
Continuous On the job training (OJT) should be undertaken for health workers to ensure that IMAM program protocol is strictly adhered to.
Non-existence of IMAM program in Hulugho division.
Sub-County health management team in Hulugho Sub County should work with supporting partners to ensure that IMAM program is initiated in all the health facilities.
Low integration of IMAM program with other services offered at the health facilities.
Mentorship should be enhanced to the health workers through OJT to ensure that screening for malnutrition is done to every child who attends the health facility.
TABLE OF CONTENTS
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ACKNOWLEDGEMENT .............................................................................................................................................. 2
ACRONYMS ................................................................................................................................................................... 3
EXECUTIVE SUMMARY ............................................................................................................................................. 4
TABLE OF CONTENTS ............................................................................................................................................... 5
LIST OF FIGURES AND TABLES .............................................................................................................................. 7
1. INTRODUCTION .................................................................................................................................................. 8
2. METHODOLOGY ................................................................................................................................................. 9
2.1 SLEAC PRIMARY SAMPLING UNITS (PSUS) ............................................................................................. 9
2.2 SLEAC SURVEY SAMPLE DESIGN ................................................................................................................ 9
2.3 COVERAGE STANDARDS AND DECISION RULES .................................................................................. 10
2.4 COVERAGE ESTIMATORS............................................................................................................................ 11
3. RESULTS .............................................................................................................................................................. 11
3.1: OUTPATIENT THERAPEUTIC PROGRAM ............................................................................................ 12
3.2 SUPPLEMENTARY FEEDING PROGRAM ................................................................................................ 16
4. CONCLUSION AND RECOMMENDATION ................................................................................................... 23
ANNEX 1: GARISSA SLEAC PARTICIPANTS ...................................................................................................... 30
ANNEX 2: GARRISA SLEAC SENSITIZATION MEETING SCHEDULE .......................................................... 31
ANNEX 3: LIST OF SAMPLED VILLAGES IN EACH SUB-COUNTY ............................................................... 32
ANNEX 4: QUESTIONNAIRE FOR CARERS OF SAM AND MAM CASES NOT IN THE PROGRAM ........ 34
ANNEX 5: WIDE AREA SURVEY TALLY SHEET............................................................................................... 35
ANNEX 6: WIDE AREA SURVEY SUMMARY SHEET ....................................................................................... 36
ANNEX 7: PARTICIPANTS DURING RESULTS PRESENTATION ................................................................. 37
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LIST OF FIGURES AND TABLES FIGURES
Figure 1: Administrative structure of Garissa County .................................................................................................. 9
Figure 2: Algorithm for a three-tier simplified LQAS classifier .............................................................................. 11
Figure 3: Map of OTP point coverage by Sub-County ............................................................................................... 13
Figure 4: Reasons for not attending OTP in Hulugho ................................................................................................. 15
Figure 5: Reasons for not attending OTP in Garissa Sub County .......................................................................... 15
Figure 6: Reasons for not attending OTP in Ijara ........................................................................................................ 16
Figure 7: Map of SFP point coverage by Sub-County ................................................................................................ 18
Figure 8: Reasons for not attending SFP in Lagdera ................................................................................................. 19
Figure 9: Reasons for not attending SFP in Dadaab .................................................................................................... 19
Figure 10: Reasons for not attending SFP in Balambala ........................................................................................... 20
Figure 11: Reasons for not attending SFP in Fafi ......................................................................................................... 20
Figure 12: Reasons for not attending SFP in Hulugho ............................................................................................... 21
Figure 13: Reasons for not attending SFP in Garissa ................................................................................................ 22
Figure 14: Reasons for not attending SFP in Ijara ....................................................................................................... 22
TABLES
Table 1: summary of program coverage assessment results .................................................................................... 4
Table 2: Summary of barriers and recommendations .................................................................................................. 5
Table3: Sample sizes and number of villages sampled.............................................................................................. 10
Table 4: Assessment data per Sub County ...................................................................................................................... 12
Table 5: OTP point coverage estimates .......................................................................................................................... 12
Table 6: Overall OTP coverage estimates ....................................................................................................................... 13
Table 7: Chi-square test analysis for OTP ....................................................................................................................... 14
Table 8: SFP point coverage estimates ............................................................................................................................ 17
Table 9: Garissa County overall SFP coverage estimate ............................................................................................ 17
Table 10: Chi-square test analysis for SFP ..................................................................................................................... 18
Table 11: County health management team and stakeholder discussions and recommendation ........... 24
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1. INTRODUCTION Garissa County is located in North Eastern region of Kenya. It covers an area of 44,174.5 km2 with an estimated population of 623,0604. The County consists of seven Sub-Counties namely Garissa, Dadaab, Lagdera, Balambala, Ijara, Fafi and Hulugho. Rainfall pattern in the County is generally erratic and unreliable. The communities living in Garissa County are majorly pastoralist (90%), agro-pastoralist (7%) and others relying on formal employment and petty trade at 3%.5 The results of Garissa County integrated nutrition survey6 revealed serious7 GAM rates of 12% (9.3-15.5 95% CI). This was a slight improvement though statistically insignificant in the nutrition situation compared to 2011 survey results (GAM 16.2%). The coverage assessment was conducted to evaluate access and coverage of IMAM program. Important to note is that the assessment was done in collaboration with nutrition partners operating in Garissa County. MOH staff from West Pokot County also joined the team as supervisors. The West Pokot team had been trained earlier in July 2013 on program coverage methodology8. Specific objectives of the program coverage assessment were:
To map out coverage for both SFP and OTP at Sub-County level. To provide an indication of coverage heterogeneity within the County. To provide an overall coverage estimate for the County. To provide relevant recommendations to enhance program coverage at the County.
This report describes the process and presents the results of the IMAM program coverage assessment conducted in Garissa County from 12th November to 3rd December 2013. The first two days were scheduled for sensitization meeting, while actual data collection process took place from 14th to 28th November 2013. Preliminary SLEAC results were shared at the County health management team (CHMT) on 29thNovember 2013 while presentation and validation of the results were disseminated on 3rd December 2013 at Garissa County health and nutrition forum.
4Kenya National Bureau of Statistics (KNBS) Census 2009. 5Long rains assessment July –August 2013 6Garissa County SMART survey April 2013 7 WHO standards 2006 8 SLEAC methodology
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2. METHODOLOGY SLEAC methodology was employed to achieve the stated objectives. SLEAC is a rapid low-resource survey method that classifies coverage (e.g. low, moderate or high) at the service delivery unit (SDU) level and can estimate coverage over several service delivery units. The Sub-counties were selected as units of classification because service delivery in Garissa County is managed at Sub-County level.
2.1 SLEAC PRIMARY SAMPLING UNITS (PSUS)
SLEAC primary sampling units (PSUs) are the most basic administrative units within a study area within which the target population is sampled from. For this survey, villages were the PSUs across Garissa County.
2.2 SLEAC SURVEY SAMPLE DESIGN
First stage sampling method: Villages were sampled in each of the Sub-counties through systematic random sampling methodology from a complete list of villages stratified by administrative units (see Figure 1). Important to note is that all villages were included in the sampling frame except for villages that were known to be insecure. The target sample size for SLEAC in each Sub-County was determined using Lot Quality Assurance Sampling (LQAS) sampling calculator.
Figure 1: Administrative structure of Garissa County
211
PSUs
211
PSUs
GARISSA
COUNTY
Dadaab Sub-County
Ijara Sub-County
Fafi Sub-County
Lagdera Sub-County
Balambala Sub-County
Garissa Sub- County
Hulugho Sub-County
Divisions
Divisions
Divisions
Divisions
Divisions
Divisions
Divisions
Divisions
Divisions
Divisions
Divisions
Location
sLocatio
ns Location
sLocatio
ns
Location
sLocatio
ns
Location
sLocatio
ns Location
sLocatio
ns
Location
sLocatio
ns
Location
sLocatio
ns
36PSU
s36PS
Us 45PSU
s45PS
Us
26PSU
s26PS
Us
20PSU
s20PS
Us
16PSU
s16PS
Us
33PSU
s33PS
Us
35PSU
s35PS
Us
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Table 3: Sample sizes and number of villages sampled
Second stage sampling method: This involved active case finding or a house-to-house screening of children 6-59 months using paediatric MUAC tape and examination of bilateral pitting oedema. During the assessment all malnourished children identified who were not in IMAM program were referred to the nearest health facility. Survey team composition: A total of 14 teams, two per Sub-County participated during the sensitization meeting and data collection exercise. The survey team comprised of one MOH staff and one program staff from the partner organizations. One SLEAC trained person was allocated per Sub-County to guide the teams in the process. Once the team arrived at the sampled villages, a village elder/CHW/area chief was identified to guide the teams during data collection. The number of villages covered in a day varied depending on the village population and accessibility. Each day, the teams would submit data to the supervisor for quality checks and compilation.
2.3 COVERAGE STANDARDS AND DECISION RULES Garissa County is a rural setting. SPHERE standards for measuring rural therapeutic feeding program s were considered and the following coverage standards were decided as most appropriate:
Low coverage: 20% or less. Moderate: 20% up to less than 50%. High coverage: 50% and above.
These standards were used to create decision rules using the following rule-of-the thumb formulae below:
⌊ ⌋ ⌊
⌋ ⌊
⌋ ⌊ ⌋ ⌊
⌋ ⌊
⌋
These decision rules were used to classify coverage in each of the seven Sub-counties where: n = sample size achieved by the survey P1= lower threshold (20%) P2 =upper threshold (50%).
PARAMETERS DADAAB IJARA FAFI LAGDERA BALAMBALA GARISSA HULUGHO
No. of villages 89 87 43 67 69 76 75 Total population 80,420 50,800 104,344 82,167 76,070 164,431 52,288
Total <5 years 14,475 9,144 16,486 14,132 10,801 26,308 9,411 Total 6-59 months
13,028 8,229 14,837 12,718 9,721 23,677 8,470
SAM caseload (0.5%)
65 41 74 63 48 118 42
Target sample size
25 21 27 25 23 31 21
Average village population (all ages)
903 584 2426 1226 1102 2,163 697
Nth villages 36 45 16 26 33 20 35
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A threshold value ( ) was established to determine the number of cases that need to be covered in order for coverage to be satisfactory as shown in Figure 2.
Figure 2: Algorithm for a three-tier simplified LQAS classifier
2.4 COVERAGE ESTIMATORS
Generally, Garissa County IMAM program is exemplified by no or low active case finding, weak community mobilisation, high defaulter and long length of stay in the program as evident from the routine data. Point coverage was therefore the most appropriate estimator to use for reporting coverage of the program. The following formula was used to calculate point coverage:
𝑃𝑜𝑖 𝑡 𝐶𝑜𝑣𝑒𝑟 𝑔𝑒 𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑐 𝑠𝑒𝑠 𝑖 𝑟𝑜𝑔𝑟 𝑚𝑚𝑒 (𝑐)
𝑇𝑜𝑡 𝑙 𝑐 𝑠𝑒𝑠 𝑓𝑜𝑢 ( )
3. RESULTS This section presents findings that include Sub-County summaries, coverage classification for both OTP and SFP and barriers to access to IMAM program. A total sample size of 78 SAM cases was obtained against a target sample size of 173. The deviation could be attributed to improved household food security at the time of assessment9. The improved nutritional status of children might have lowered the SAM caseload considering that SAM prevalence was derived from April 2013 integrated
9 Long rains assessment 2013
Classify as
MODERATE
Sample
Classify as
HIGH
Classify as
LOW
Number of
cases
covered
exceeds d2
d2d2?
Number of
cases
covered
exceeds d1
ddjmkdd1d
1?
NO NO
YES YES
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nutrition survey. The measure of coverage provides solely classification of coverage that is below or above a threshold as per the LQAS methodology employed. The lower-than-expected sample does not significantly affect the reliability of the results presented. Table 4 summarizes the SLEAC results for each Sub-County and overall County value. Table 4: Assessment data per Sub-County
Sub-County Target sample size (SAM )
SAM cases found (<11.5cm) (n)
SAM cases in OTP (<11.5cm) (c)
In OTP recovering(>11.5cm)
MAM Cases found(>11.5-<12.5cm)
MAM Cases in SFP(>11.5-<12.5cm)
In SFP Recovering(>12.5cm)
Total screened
Fafi 27 4 1 8 21 10 22 8,59
Ijara 21 22 19 21 135 82 7 2,982
Garissa 31 7 0 3 24 5 5 1,920
Balambala 23 7 6 12 49 8 50 1,447
Hulugho 21 27 6 0 210 58 33 2,818
Lagdera 25 6 6 6 46 37 27 1,729
Dadaab 25 5 4 10 16 7 7 2,846
County 173 78 42 60 501 207 151 14,601
3.1: OUTPATIENT THERAPEUTIC PROGRAM Table 5 summarizes OTP point coverage results and provides a coverage classification based on the decision rule. Table 5: OTP point coverage estimates Sub-County SAM cases
found (n) SAM cases in OTP (c)
Decision rule (d1)
Is c >d1?
Decision rule (d2)
Is c >d2?
Coverage Classification
Fafi 4 1 0 Yes 2 No Moderate
Ijara 22 19 4 Yes 11 Yes High
Garissa 7 0 1 No 3 No Low
Balambala 7 6 1 Yes 3 Yes High
Hulugho 27 6 5 Yes 13 No Moderate
Lagdera 6 6 1 Yes 3 Yes High
Dadaab 5 4 1 Yes 2 Yes High
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Figure 3: Map of OTP point coverage by Sub-County Four Sub-counties as shown in figure 3 achieved the SPHERE standards of ≥50%. Garissa Sub-County had the lowest coverage with none of the severely malnourished children assessed covered by the program. Weighted analysis for OTP coverage for the entire Garissa County was 48.7% (40.9-56.5 95%
C.I.) classified as moderate. Table 6 below shows the weighted analysis for OTP coverage estimate.
Table 6: Overall OTP coverage estimates
Sub-County
Total population
% of <5 % of (6-59)
SAM prevalence (SMART April 2013)
N W=N/ΣN (W Xc/n]
Fafi 104,344 15.8 90 0.5% 74 0.164 0.041 Ijara 50,800 18 90 0.5% 41 0.091 0.079 Garissa 164,431 16 90 0.5% 118 0.262 0 Balambala 76,070 14.2 90 0.5% 48 0.106 0.091 Hulugho 52,288 18 90 0.5% 42 0.093 0.021 Lagdera 82,167 17.2 90 0.5% 63 0.140 0.14 Dadaab 80,420 18 90 0.5% 64 0.144 0.115
1 Σ(WXc/n)=0.487
The OTP coverage across Sub-counties was heterogeneous thus the overall County estimate should be interpreted cautiously. There was a significant difference between the expected and observed results; this is illustrated by chi-square test analysis obtained as indicated in table 7. The chi-square test value
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obtained was 18.04 which is greater than the critical value of 12.59 (for seven Sub-Counties), thus the coverage was patchy. Table 7: Chi-square test analysis for OTP
Sub-County Sample size
Observed (O )
Expected (E) (0 − E )2
( )
Fafi 4 1 4
= 2.15 ( ) 1.32
0.61
Ijara 22 19
11.85 ( ) = 51.12
=4.31
Garissa 7 0
3.77 ( ) 14.21
= 3.77
Balambala 7 6
3.77 ( ) = 4.97
1.32
Hulugho 27 6
( ) = 72.93
5.02
Lagdera 6 6
3.23 ( ) = 7.67
2.37
Dadaab 5 4
2.69 ( ) = 1.72
0.64
SUM 78 42 42 18.04
Barriers to OTP uptake and access
Various issues were identified as reasons why severely malnourished cases not covered were not attending OTP. These are classified according to respective Sub-Counties. Hulugho Sub-County Lack of IMAM program was the main barrier in Hulugho Sub-County (Figure 4). The entire Hulugho division did not have any facility or outreach offering IMAM services. In other divisions namely Sangailu and Bothai previous rejection was cited by many caregivers; with an explanation that the community health workers did not admit the children to the program supposedly to reduce their workload. This indicates that some CHWs do not understand their roles thus regular OJT and close supervision is vital.
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Figure 4: Reasons for not attending OTP in Hulugho
Garissa Sub-County Discharged while not cured came out strongly as the main barrier in Garissa Sub-County (Figure 5). A case scenario was a severely acute malnourished child with medical complications who had been admitted to the stabilization centre at Provincial General Hospital. After meeting discharge criteria, the child was not transferred to OTP but was rather sent home. Other reasons affirmed by caregivers were that they had other competing duties to attend to and thus had no time to attend to the program. Difficulties with childcare and previous rejection were also cited by some of the caregivers.
Figure 5: Reasons for not attending OTP in Garissa Sub-County Ijara Sub-County There were three main reasons for not attending to OTP in Ijara namely; Defaulting, inconsistency of outreach services and caregivers being too busy to attend to the program because they had other household chores to attend to (Figure 6).
0% 10% 20% 30% 40% 50% 60% 70% 80%
No IMAM programme
Previous rejection
Site too far
Defaulted
Proportion of children not covered
Reasons for not attending OTP in Hulugho
0% 5% 10% 15% 20% 25% 30% 35% 40% 45%
Discharged not cured
No time/too busy
Difficulty with child care
Previous rejection
Proportion of children not covered
Reasons for not attending OTP in Garissa
16
Figure 6: Reasons for not attending OTP in Ijara
Dadaab Sub-County Dadaab had one major issue; RUTF stock-out. It was noted during brainstorming session that initially Dadaab did not have a store previously thus they obtained supplies from Lagdera Sub-County. Delay in submission of monthly reports leading to a delay in delivery of the supplies was cited from discussion as an attribute to RUTF stock out. Informal interviews indicated some of the boosters as good program awareness and active case finding. Balambala Sub-County Absenteeism and shortage of health workers with some health centres being run by one health worker was the major issue in Balambala. Caregivers cited that most of the time they go to the health facility to seek for services, they find it closed because the health worker is away. This was also mentioned during brainstorming session that based on previous supervision reports there has been serious absenteeism in Balambala Sub-County specifically in two health facilities (Jarajara and Daley). Fafi Sub-County Lack of outreach services was the only barrier in Fafi Sub-County as the Sub County is vast with long distances to health facilities. Community near Hagadera refugee camp were not allowed to get services at the camp. Lagdera Sub-County All the severely malnourished children found in Lagdera were attending the program. Active case finding was mentioned as the key to success in Lagdera Sub-County.
3.2 SUPPLEMENTARY FEEDING PROGRAM Table 8 summarizes SFP point coverage results and provides a coverage classification based on the decision rule.
0% 5% 10% 15% 20% 25% 30% 35%
Defaulted
No time/too busy
IMAM programme defaulted
Proportion of children not covered
Reasons for not attending OTP in Ijara
17
Table 8: SFP point coverage estimates
Sub-County
MAM cases found (n)
MAM cases in SFP (c)
Decision rule (d1)
Is c >d1?
Decision rule (d2)
Is c >d2?
Coverage Classification
Fafi 21 10 0 Yes 10 No Moderate
Ijara 135 82 27 Yes 67 Yes High
Garissa 24 5 4 Yes 12 No Moderate
Balambala 49 8 9 No 24 No Low
Hulugho 210 58 42 Yes 105 No
Moderate
Lagdera 46 37 9 Yes 23 Yes
High
Dadaab 16 7 3 Yes 8 no Moderate
Balambala Sub-County had the lowest SFP point coverage below 20% with Lagdera and Ijara Sub-counties meeting the SPHERE standards above 50%. Weighted analysis for SFP coverage for the entire Garissa County was 40.7% (35.6-45.8 95% C.I.) classified as moderate. Table 9 shows the weighted analysis for SFP coverage estimate. Table 9: Garissa County overall SFP coverage estimate
Sub County
Total population
% of <5 % of (6-59)
MAM prevalence
N W=N/ΣN (W Xc/n)
Fafi 104,344 15.8 90 3.9% 578 0.164 0.078 Ijara 50,800 18 90 3.9% 320 0.091 0.055 Garissa 164,431 16 90 3.9% 923 0.261 0.054 Balambala 76,070 14.2 90 3.9% 379 0.107 0.018 Hulugho 52,288 18 90 3.9% 330 0.093 0.026 Lagdera 82,167 17.2 90 3.9% 496 0.14 0.113 Dadaab 80,420 18 90 3.9% 508 0.144 0.063
3534 1 Σ(W Xc/n)=0.407
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Figure 7: Map of SFP point coverage by Sub-County
The SFP coverage across Sub Counties was heterogeneous. There was a significant difference between the expected and observed results; this is illustrated by chi-square test analysis obtained as indicated in table10. The chi-square test value obtained was 48.94 which is greater than the critical value of 12.59 (for seven Sub-Counties), thus the coverage was patchy. Table 10: Chi-square test analysis for SFP
Sub-County
Sample size
Observed (O )
Expected (E) (0 − E )2
( )
Fafi 21 10 21
= 8.68 ( ) 1.74
0.200
Ijara 135 82
55.78 ( ) = 687.49
=12.32
Garissa 24 5
9.92 ( ) 24.21
= 2.44
Balambala 49 8
20.24 ( ) = 149.82
7.37
Hulugho 210 58
86.77 ( ) = 827.71
9.54
Lagdera 46 37
19.00 ( ) = 324
17.05
Dadaab 16 7
6.61 ( ) = 0.15
0.02
SUM 501 207 207 48.94
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Barriers to SFP uptake and access
Reasons for moderately malnourished children not covered by SFP are categorised according to respective Sub Counties. Defaulting is a major issue across most of the Sub Counties due to long distances and difficult with child care. In adequate screening and relapse also came out strongly as some of the reasons the cases were not covered. Lagdera Sub-County The main barrier to SFP coverage in Lagdera was long distance and lack of means of transport to the program delivery point (Figure 8).
Figure 8: Reasons for not attending SFP in Lagdera Dadaab Sub-County Child not screened at the facility/ outreach site was the main reason cited by the caregivers in Dadaab Sub-County. This is an evidence of inadequate active case finding at the outreach sites and low passive screening at the health facilities. Other reasons included previously rejected for the program whereby carers of rejected children become unwilling to attend the program even when their children health condition deteriorates. Others were too busy with other chores therefore could not attend to the program (Figure 9).
Figure 9: Reasons for not attending SFP in Dadaab
0% 5% 10% 15% 20% 25% 30% 35%
Site too far
Discharged as cured
Difficulty with child care
Child not screened at health…
Defaulted
Proportion of children not covered
Reasons for not attending SFP in Lagdera
0% 10% 20% 30% 40% 50% 60%
Child not screened in the…
No time/too busy
Previous rejection
Proportion of children not covered
Reasons for not attending SFP in Dadaab
20
Balambala Sub-County The main reason cited by carers in Balambala Sub-County for not attending the program was previously discharged as cured; which relapse of acute malnutrition. Defaulting and child not being screened also came out strongly. Caregivers whose children were not screened mentioned that they had been in the health facility for other services but their children were not screened, indication of inadequate passive screening at the health facilities (Figure 10).
Figure 10: Reasons for not attending SFP in Balambala
Fafi Sub-County The main reason reported was that the site for IMAM program was too far and there were no outreach services to the villages (Figure 11). Other reasons included lack of integrated10 program, not allowed to attend to the program in Hagadera refugee camp and previously discharged as cured.
Figure 11: Reasons for not attending SFP in Fafi
10
Only immunization services are undertaken at the outreach sites
0% 5% 10% 15% 20% 25% 30% 35% 40%
Discharged curedDefaulter
Child not screenedNo time/too busy
Site too farHousehold migrated far away
Previous rejection
Proportion of children not covered
Reasons for not attending SFP in Balambala
0% 5% 10% 15% 20% 25% 30% 35% 40% 45%
Site too farProgram not integrated with outreach
IMAM program only for refugeesDischarged cured
DefaulterNo outreach
Proportion of children not covered
Reasons for not attending SFP in Fafi
21
Hulugho Sub-County No knowledge of IMAM program in Hulugho Division was the main barrier (Figure 12). Poor adherence to IMAM program protocol by health workers was evident, about 16% of the caregivers cited that their children were discharged before they got cured. There was also inadequate integration of IMAM program with other services since children seeking other services were not screened in some health facilities and outreach sites. This is also an indication of inadequate active and passive case finding. Defaulting and difficulty with childcare and previous rejection was evident in the other divisions which have IMAM program.
Figure 12: Reasons for not attending SFP in Hulugho
Garissa Sub-County Difficulty in childcare was the main reason cited in Garissa Sub-County; most caregivers stated that they were unable to attend to the program because they had other children to take care of (Figure 13). Previous rejection was also highly cited; carers whose children had been previously screened and rejected never bothered to attend to the program again.
0% 10% 20% 30% 40% 50% 60% 70% 80%
No IMAM programme
Defaulter
Difficulty with child care
Previous rejection
Site too far
RUSF stock out
No time/too busy
Discharge not cured
Child not screened
Discharge cured
Proportion of children not covered
Reasons for not attending SFP in Hulugho
22
Figure 13: Reasons for not attending SFP in Garissa
Ijara Sub-County Defaulting was the main reason moderately malnourished children were not covered in SFP. Previous rejection, relapse cases and inadequate screening also highly contributed to non-attendance to SFP program (Figure 14). Carers whose children had been previously screened and rejected due to various reasons would never bother to attend to the program again. Some of these carers had been told that their child was not malnourished and would not be admitted to the program, or that there were no rations for SFP thus the child could not be admitted to the program. Observations and informal interviews indicated that the program awareness among the care givers was good, as well as existence of active case finding.
Figure 14: Reasons for not attending SFP in Ijara
0% 5% 10% 15% 20% 25%
Difficulty with child carePrevious rejection
DefaulterPrevious rejection
Child not screened in hospitalSite too far
Discharged curedNo time/too busy
Proportion of children not covered
Reasons for not attending SFP in Garissa
0% 5% 10% 15% 20% 25% 30% 35%
Defaulter
Previous rejection
Discharge as cured
Child not screened in hospital
No time/too busy
Site too far
never interested in programme
Discharge as not cured
Proportion of children not covered
Reasons for not attending SFP in Ijara
23
4. CONCLUSION AND RECOMMENDATION Most barriers identified during the SLEAC assessment points to weak community mobilisation component of the IMAM program, poor adherence to IMAM protocol by health workers and low integration of the program with other services in the health facilities in Garissa County. The program should therefore invest adequate resources (time, financial and human) into community-based activities to ensure optimal service delivery.
Further SQUEAC investigations in a Sub-County with low coverage (Garissa) and another with high coverage (Lagdera) is recommended. This will gather in depth information on the barriers which could be used to reform the program as well as boosters which other Sub-counties can adopt to improve their program coverage.
Table 11 indicates the possible recommendations specified for each Sub-County. This will call for more actions through prioritized interventions to ensure attainment of SPHERE minimum standards of above 50% as depicted for rural settings.
24
Table 11: County health management team and stakeholder discussions and recommendation
Issues arising Sub-County Recommendations Action Plan Process indicators Responsible Outreach program is not integrated with IMAM; only immunization services are undertaken at the outreach sites.
FAFI Ensure at all times that outreach services are fully integrated so that the members of the community far from the health facilities can as well receive the essential health care.
Advocate for integrated outreaches by all the partners.
Integrated outreaches conducted in all the villages far from the health facilities
MOH and supporting partners
Lack of outreach services to most of the villages far from the health facilities and therefore the caregivers do not know of program s that treat acute malnutrition
FAFI Scale-up outreach services to areas not covered and enhance community mobilization and sensitization.
Proper identification and mapping all the villages in need of outreach services by MOH and partners. MOH allocating the outreach sites to the different partners for support. Conduct community awareness sessions on IMAM and to increase population awareness about acute malnutrition.
All outreach sites identified and clearly mapped out. All the outreach sites functional and supported Key messages developed and disseminated.
MOH and supporting partners
Host communities are not allowed to attend to IMAM
FAFI Outreach services should be undertaken at the host
Lobby with agencies supporting refugee
Meetings with stakeholders planned
MOH and supporting
program in Hagadera since it is only for refugees.
community program to initiate a host community program
and conducted partners
There was inconsistency of outreaches with some villages totally stopped without the knowledge of the caregivers.
IJARA Ensure that there is consistency in the delivery of program outreaches There should be improved communication among all stakeholders on the management of outreaches..
All partners to share quarterly activities and close monitoring and feedback enhance through Sub-County NTFs. Exit plan should also be developed during the initial phase of the program
Quarterly plans developed and reviewed regularly.
MOH and supporting partners
Difficulty in childcare was the main reason cited in Garissa Sub-County; most caregivers stated that they were unable to attend to the program because they had other children to take care of too.
GARISSA Sensitization of the mothers on the importance of the program. Identify mentor mothers through mother to mother support groups who will assist them understand child health and also other services available such as family planning etc.
Identify the mothers affected by the problem and link them with mentor mothers. Organize activities to be undertaken through MTMSGs
Appropriate activities organized and implemented.
MOH and supporting partners
The Sub-County has shortage of health workers such that some health centres are run by one health worker. Nonetheless it was noted that there is a serious absenteeism in some health facilities specifically in Jarajara and Daley and this clearly has a negative impact on program coverage.
FAFI Regular supervision of health workers should be enhanced. Follow-up and feedback mechanisms strengthened.
Undertake monthly joint supervision and mentoring of health workers. Lobby at the County level to ensure that more health workers are employed and deployed.
Supervision schedules and reports compiled. More health workers deployed at the health centres.
CHMT and Sub-CHMT
Lack of IMAM program in the entire Hulugho division, and most of the caregivers were not aware of the program.
HULUGHO IMAM program should be put in place in Hulugho division. Intensive community mobilization and sensitization should be undertaken.
The DNO -Ijara to have a meeting with supporting partners on possibility of jumpstarting IMAM program at Hulugho Sub District Hospital as a matter of urgency.
Gaps identified, report compiled and appropriate capacity building of health workers done before the program is started.
MOH to spearhead. Partners supporting nutrition in the county.
It was noted that there is low staffing, low immunization, and high malnutrition. Lack of reporting because there is few technical staff to write the reports or analyse the situation on the ground. Two health facilities are also
HULUGHO To ensure effective implementation of IMAM program, key strategies need to be devised by MOH and partners to improve service delivery and fill staffing gaps in the Sub county.
Re-open the closed health facilities and deploy health workers to offer the services.
All closed facilities opened and staff deployed
CHMT and Sub-CHMT
closed due to lack of staff to offer the services.
Previous rejection at the health facility mainly by the community health workers who avoid admitting eligible children to ease workload.
HULUGHO Identify CHWs who can support at the facility when the facility staffs are not there in order to avoid interruption of services and neglect of patients especially in facilities which have only one health worker. Health workers should closely supervise CHWs.
Community to identify the CHW and facility in-charge undertake OJT
CHWs identified and trained
Facility in-charges, community leaders.
Distance to the health facility. LAGDERA Increase outreach/mobile sites to address the problem of distance.
Mapping of all villages far from the health facilities and ensure that they are reached through outreaches.
Outreach schedule covering all the villages developed and implemented.
MOH and partners
RUTF/RUSF stock-out renders caregivers reluctant to attend to IMAM program. It was noted during discussion that commodity dispatch depends on timely and quality reports from the health facilities which is not the case in many health facilities. There has also been poor
DADAAB Mentoring through OJT should be undertaken to ensure that timely good quality reports are submitted. Proper coordination and communication should be enhanced between the
Nutrition reports should be properly reviewed before submission to the DHIS. All communication should be done in writing to improve accountability
RUSF/RUTF requested early enough and no stock-out at all times.
KRCS, MOH, WFP
supply coordination by the WFP cooperating partner leading to delayed deliveries and supply of short expiry commodities to facilities.
MOH and the KRCS to improve the supply chain of nutrition commodities
and service delivery.
There is high defaulting, a great barrier to program coverage
IJARA BALAMBAL
A HULUGHO
Establish the root cause of high defaulter rate. The health workers together with supporting partners should establish a strategy to ensure that all defaulters are traced and brought back to the program.
Sensitise the community on the importance of consistent attendance to IMAM program. Involve CHWs to trace the defaulters
Monthly review of the defaulters traced at the facility level.
MOH and partners
There is high relapse of acute malnutrition.
FAFI, BALAMBALALAGDERA
Identify the reasons for relapse and ensure that the underlying causes of malnutrition are addressed by linking the affected children to the appropriate program s
Multi-sectoral collaboration with other sectors such as WASH, FSL
Underlying causes of malnutrition identified and addressed
MOH and partners supporting nutrition, WASH and FSL activities
Previous rejection by the program was evident; the Carers of previously rejected children were unwilling to attend the program even when their children's condition
DADAAB IJARA GARISSA
To enhance proper and continuous program sensitisation at community level to ensure that all the key issues and protocols are known by the
Mentor program staff through OJT.
OJT schedule developed and implemented
Program staff, CHMT and partners
deteriorates. community. Poor integration of IMAM program with other services in the health facility. Low active case finding
BALAMBALAGARISSA
IJARA DADAAB
Mentorship should be enhanced to the health workers through OJT to ensure that screening for IMAM program is done to every child who attends the health facility at all entry points. Conduct quarterly mass MUAC screening and sensitization campaigns in the whole Sub-County.
Set up quarterly OJT activity schedules which should be evaluated. Partners to have a budget for quarterly mass MUAC screening
OJT checklists developed, reports reviewed and compiled Mass screening activity scheduled for each quarter developed and implemented.
MOH and supporting partners
30
Annex 1: Garissa SLEAC participants NO NAME AGENCY POSITION 1 ABDI ADEN KOSAR APD Nutrition Officer 2 ABDIAZIZ RONE ELMI MOH- IJARA Nutritionist 3 ABDIKADIR ABDALLA ACF HiNi Officer 4 ABDIMALIK IBRAHIM MOH- IJARA DNO
5 ABDULLAHI MOHAMED MERCY USA Community Mobilizer 6 ADAN DAGANE GEDI MERCY USA Community Mobilizer 7 AHMED HAJI MOH- GARISSA CPHO 8 AHMED HASSAN MOH- LAGDERA Nutritionist
9 ALI AMIN ACF Volunteer/ Enumerator 10 ALIBILE AHMED ACF Nutrition Officer 11 ALISIA OSIRO ACF Nutrition program Manager 12 ASLI AHMED MOH- DADAAB Nutritionist 13 CAROLINE MWANIKI MOH- GARISSA Nurse
14 CLAUDET K. BARAZA MOH- FAFI Nurse 15 FAITH NZIOKA ACF FSNS Ass. Program Manager
16 GULED AHMED MERCY USA Enumerator 17 HASSAN ALI MERCY USA M & E officer 18 HUSSEIN IBRAHIM APD Nutrition Officer 19 KEVIN MUTEGI ACF FSNS Officer 20 LATHAN OSMAN MOH- GARISSA Nurse 21 LAURA KIIGE UNICEF Nutrition Officer 22 LEAH CHELOBEI MOH –WEST POKOT CNO 23 LILIAN BIWOTT MOH- BALAMBALA Nurse 24 MARK MIRITI MOH- BALAMBALA Nurse 25 MERAB APONDI MERCY USA Field Coordinator 26 MOHAMED ALI OMAR MERCY USA Community mobilizer
27 MOHAMED MALELE MOH- DADAAB Nutrition Nurse
28 MOHAMUD OSMAN MERCY USA Deputy Field Coordinator 29 MUSA INDETIE MOH- GARISSA Ag CNC 30 MUSA TOTO MOH- LAGDERA DNO 31 OWAKA ISAAC MOH - WEST POKOT PHO 32 PAULINE WAWERU MOH- HULUGHO Clinical Officer
33 RAGOW GABOW TDH HNE 34 ROSELYNE ARUSEI ACF FSNS Officer 35 SULEIMAN M. KHALIF MOH- HULUGHO Nurse 36 UBAH MUSTAFA MERCY USA Intern/Enumerator 37 VIVIAN KENDUIYWA MOH- FAFI DNO
38 YUSUF ALI ACF Nutrition Deputy Program Manager
31
ANNEX 2: Garrisa SLEAC sensitization meeting Schedule Sensitization meeting held in Nomads hotel, Garissa
Date Time Activity schedule Key person
12/11/2013 8:00am Arrival
8:05AM-8:10am Introduction MoH
8:10AM Opening remarks by County health coordinator
Dr. Mohammed A. Sheikh.
8:30AM-10:00am
An overview of objectives of program coverage assessment
Faith and Laura
10:00pm-10:30pm
Tea break
10:30pm-1:00pm
SLEAC Methodology Kevin and Leah
1:00pm-2:00pm Lunch break
2:00pm-4:00pm Field procedures MOH staff at each Sub-County, Alisia, Hassan and Merab
Overview of complete villages in Sub-Counties
Sampling of villages per Sub-County Hassan and Kevin
4:10pm Participants can leave at their own pleasure
13/11/2013 8:00am Arrival
8:10am-9:300am
Finalization of field procedures Hassan and Kevin
How to conduct MUAC measurements/Oedema examination
Musa Indetie
Overview of data collection tool and tally sheet
Faith and Isaac
Calendar of events Hassan
9:30-10:00am Movement plan Faith and Roselyn
10:00am Tea break To be shared among team leaders
Teams to depart to their respective allocated Sub-County
32
ANNEX 3: List of sampled villages in each Sub-County
S/NO LAGDERA DADAAB BALAMBALA GARISSA FAFI HULUGHO IJARA 1 Bulla Madina Bulla township Balambalacentre Shimbirey Mansabubu Hulughocentre Arislay 2 Bulla Kuwait FafahKalaa Bulla msikiti Bulla Mzuri Mathabgesi Bulla ahmed BulaSarman 3 Elanle Bulla Guro Bulla Hospital Bulla Hajji Welmerer Jilomata BulaDahir 4 Barfin Waanri Bulla Gun Toure Kiwanja Kabasalo Kalangalderow 5 Skansaka Marodhiley Jarajara Dololoweyne Buiyoadhan Dafedam Dabarmatan 6 Gosma Abdisamad Hifow Barka Inyasin Korahindi Gababa 7 Garse Bulla Gussa Kone Faryar Bogour Bulla Iftin Dahir 8 Janju Bulla Riig Hagarjarer Eldere Jelow Korogai Danai 9 Qurahey and Libahlow Daley centre Sanbul Hasisimey Hursan Alijarire
10 Garson Bulla Banan Der derey Bulla kari Mufti Gololbele Hubi 11 Fadiweyn Labasigale Welmarer Jarirof Degwardey Kulan Abalatirow
12 Dal Lehele Aligabey AgalAar DekaBune Guyo Boni BulaWaraday 13 Bulla kulan Bulla sheikh Danyere center Bulla Adaan Bulla sharif Junction Gerille 14 Bulla Secondary Bulla deka Bulla Tunki Bulla Punda Warable Iredkele Hussein Katalo 15 Benane township Bulla crush Bulla Gullet Ziwani Ruqa Doy Gurei 16 Kambisamaki Bulla primary Elane Kambi Moto Degwardey Baldig MAAH-V-DAM 17 Eldere township Bulla Dana Gawan Al-faruq Saberal Dama
18 Sarti Bulla School Kasha centre Bulla Riiq Kolosh dam Moit
19 Labile Uthole Bulla Hagar Bulla Tawakal Bobtay Dabelweeyne
20 Jilango Sarira Omar Muhamud Bulla Iskadek Dibayu konodinto 21 Goriale township Bulla Gudud Ohio
Bultuhama Konodinto
22 Bulla Abey Bulla Deka Mudey Bulla gogor Gumarey 23 Bulla Oscar Bahuri Bulla mobile
Kartoub Bulla godon
24 Ahmed Tukale Bulla Qalbidawac Damaja Mataarba Sagar
25 Sabena Bulla Riig Gabobey Arab dere QololDerow 26 Tuere Bulla Mosque Fardiweyne Goloshgutu Konso 27 Bulla AP Hirbai Maradulow Livestock
28 safaricom Habarow Kenisaa Asmali 29 Abdisugow Gel disdis Wakabharey Warlay 30 DamajaleAbak Halkano Gololo Ijaracentre 31 Bulla red cross Kora Harerdero Sangoleycentre 32 Bulla Kiwanja Sickley Ege Bulawacha 33 Bulla carlifornia Kiwanjandege Irekharwa Agudaley 34 Bulla daresalaam Habarkolisa Sufi Bashir 35 Madhahgisi Gundi 36 Malayley 2 Hamorat 37 BulaHawo 38 BulaFarow 39 BulaHidaya 40 BulaGuwa 41 Abdigure 42 Ndapia 43 Bulla Dakran 44 Turkata 45 Ruqa
ANNEX 4: Questionnaire for carers of SAM and MAM cases not in
the program Sub-County:_________________________________Village__________________________ Team No.___________________________________Date____________________________ 1. Do you think that this child is malnourished? 1. YES 2. NO □ 2. Do you know of a program that can treat malnourished children? 1. YES 2. NO □ IF YES... 3. What is the name of this program? ___________________________________________________ 4. Where is this program? ___________________________________________________ 5. Has this child ever been to the program site or examined by program staff? 1. Yes 2. NO □ If YES... 6. Why is this child not in the program now?
□Previously rejected □Defaulted □ Discharged as cured □ Discharged as not cured □Other reasons___________________________________________
7. If YES in Qn 2 and NO in Qn 5 then why is this child not attending this program? Do not prompt. Probe ‘Any other reason?’(I. YES 2. NO)
□ Program site is too far away □ No time/too busy to attend the program □ Carer cannot travel with more than one child □ Carer is ashamed to attend the program □ Difficulty with childcare □The child has been rejected by the program □Other reasons___________________________________________
35
ANNEX 5: Wide Area Survey Tally sheet Sub-County:______________Village:______________________ Team: _______Date:_____________
# OF SAM CASES FOUND (MUAC ≤11.4/oedema)
SAM CASES IN OTP (MUAC ≤11.4/oedema)
IN OTP PROGRAM BUT RECOVERED (MUAC or no oedema)
# OF MAM CASES FOUND (MUAC ≥11.5- ≤12.4)
MAM CASES IN SFP (MUAC ≤12.4)
IN SFP PROGRAM BUT RECOVERED (MUAC ≥12.5)
00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000
Total children 6-59 months screened 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000
00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000
00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000
36
ANNEX 6: Wide area survey summary sheet SLEAC SUMMARY SHEET
Date:…………………………....Sub-County………………………...Name of team leader……………………...... Team no:……...................................
Name of the village
Total number of SAM cases found (MUAC <11.5/ oedema)
Total number of SAM cases in OTP (MUAC <11.5/ oedema)
Total number in OTP program but recovering (MUAC ≥ . or no oedema)
Total number of MAM cases found (MUAC ≥11.5- <12.5)
Total number of MAM cases in SFP (MUAC <12.5)
Total number of cases in SFP program but recovering (MUAC ≥12.5)
Total children 6-59 months screened
37
ANNEX 7: Participants during results presentation
Name
Designation
Organization Email Address
Cell-phone
Dr. Mohamed Abbey County DH
MOH
0722111263
Dr. Sofia Mohamed
Chief Officer of Health
MOH
0725300625
Musa Indetie Ag. CNC MOH
[email protected] 0724940474
Abdimalik Ibrahim DNO (Ijara) MOH [email protected] 0722646373 Bashir Hassan DPHN (DDB) MOH [email protected] 0721270698 Mohamed M. Abdi Ag.DMOH (DDB) MOH [email protected]
m 0717057288
AbdirashidDiney DMOH Hulugho MOH [email protected] 0720918149 Aden Musa Nutrition Officer IRC [email protected]
rg 0724872764
Dr. Ochieng Erick DMOH MOH [email protected] 0726142614 Hassan M Hassan DMOH MOH [email protected] 0721544392 Hassan Anshur DPHN (Ijara) MOH [email protected] 0720265250 DabasoJillo FC MSF [email protected] DaudHirey DMOH, Lagdera MOH [email protected] 0720326580 Pauline Akoth RNO KRC Omolo.pauline@kenyaredcr
oss.org 0724294777
Alicia Bonnie NUT PM ACF [email protected]
0707181422
Dr. Farah Amin DMOH MOH [email protected] 0710719920 Francis Kidake NSO (Dadaab) UNICEF [email protected] 0728592369 Antony Kanja NUT. OFFICER KRCS Kanja.antony@kenyaredcro
ss.org 0728067350
Dr. sanjeevVerma HPM TDH Hpm.ke@tdh-ch 0706056636 Amina Maalim CPN KRCS [email protected]
m 0729276031
MerabApondi FC MERCY USA [email protected] 0721124727 Kevin Mutegi FSNS OFFICER ACF Fsnsoff-nbo@acf-
international.org 0725635303
Musa Toto DNO MOH [email protected] 0723988593 Pamela Kaguri NUT. Officer MOH [email protected] 0718255467 Hussein Mohamed Alio
CDIO NDMA [email protected] 07229088457
AlkajeroGitari DPHN (Hulugho) MOH [email protected] 0725593367 Dr. Njoroge PMCC MOH [email protected] 0729682838 Omar Mahat CMLS MOH [email protected] 0726794527 Mohamed Yussuf CHOP MOH [email protected] 0723782547
38
Evan Bett M&E (ACF) ACF m&[email protected]
0707181420
Siyat Hassan DPHN (FAFI) MOH-FAFI [email protected] 0722947573 Mohamed Salat CNO MOH [email protected] 0721424557
